Cost-effectiveness Of HIV Testing Research Articles

Health Impact and Cost-Effectiveness of HIV Testing, Linkage, and Early Antiretroviral Treatment in the Botswana Combination Prevention Project.

Background:The Botswana Combination Prevention Project tested the impact of combination prevention (CP) on HIV incidence in a community-randomized trial. Each trial arm had ~55,000 people, 26% HIV prevalence, and 72% baseline ART coverage. Results showed intensive testing and linkage campaigns, expanded antiretroviral treatment (ART), and voluntary male medical circumcision (VMMC) referrals increased coverage and decreased incidence over ~29 months follow-up. We projected lifetime clinical impact and cost-effectiveness of CP in this population.Setting:Rural and peri-urban communities in Botswana.Methods:We used the Cost-Effectiveness of Preventing AIDS Complications (CEPAC) model to estimate lifetime health impact and cost of 1) earlier ART initiation, and 2) averting an HIV infection, which we applied to incremental ART initiations and averted infections calculated from trial data. We determined the incremental cost-effectiveness ratio (ICER, US$/QALY) for CP vs. standard of care.Results:In CP, 1,418 additional people with HIV initiated ART and an additional 304 infections were averted. For each additional person started on ART, life expectancy increased 0.90 QALYs and care costs increased by $869. For each infection averted, life expectancy increased 2.43 QALYs with $9,200 in care costs saved. With CP, an additional $1.7 million were spent on prevention and $1.2 million on earlier treatment. These costs were mostly offset by decreased care costs from averted infections, resulting in an ICER of $79 per QALY.Conclusions:Enhanced HIV testing, linkage, and early ART initiation improves life expectancy, reduces transmission, and can be cost-effective or cost-saving in settings like Botswana.

Expanded HIV testing in low-prevalence, high-income countries: a cost-effectiveness analysis for the United Kingdom.

ObjectiveIn many high-income countries with low HIV prevalence, significant numbers of persons living with HIV (PLHIV) remain undiagnosed. Identification of PLHIV via HIV testing offers timely access to lifesaving antiretroviral therapy (ART) and decreases HIV transmission. We estimated the effectiveness and cost-effectiveness of HIV testing in the United Kingdom (UK), where 25% of PLHIV are estimated to be undiagnosed.DesignWe developed a dynamic compartmental model to analyze strategies to expand HIV testing and treatment in the UK, with particular focus on men who have sex with men (MSM), people who inject drugs (PWID), and individuals from HIV-endemic countries.MethodsWe estimated HIV prevalence, incidence, quality-adjusted life years (QALYs), and health care costs over 10 years, and cost-effectiveness.ResultsAnnual HIV testing of all adults could avert 5% of new infections, even with no behavior change following HIV diagnosis because of earlier ART initiation, or up to 18% if risky behavior is halved. This strategy costs £67,000–£106,000/QALY gained. Providing annual testing only to MSM, PWID, and people from HIV-endemic countries, and one-time testing for all other adults, prevents 4–15% of infections, requires one-fourth as many tests to diagnose each PLHIV, and costs £17,500/QALY gained. Augmenting this program with increased ART access could add 145,000 QALYs to the population over 10 years, at £26,800/QALY gained.ConclusionsAnnual HIV testing of key populations in the UK is very cost-effective. Additional one-time testing of all other adults could identify the majority of undiagnosed PLHIV. These findings are potentially relevant to other low-prevalence, high-income countries.

Cost-effectiveness analysis of HIV testing strategy in hospitals from 2006 to 2010 in Guangzhou

To evaluate the cost effectiveness of HIV testing strategy in hospitals from 2006 to 2010 in Guangzhou. According to the HIV test strategy costs and the number of HIV patients found in Guangzhou, following aspects were calculated as the total cost of HIV testing strategy in hospitals from 2006 to 2010 of Guangzhou, the cost of finding each HIV patient, and the cost of obtaining one quality adjusted life year (QALY) using Markov model. The total HIV test strategy costs increased from 11 106.98 thousand Yuan to 25 105.58 thousand Yuan, and 4599 HIV positive patients were found due to this strategy. The cost-effectiveness of HIV testing were different in hospitals from 2006 to 2010 in Guangzhou. The lowest cost-effectiveness ratio of HIV testing strategy was 11 810 Yuan per HIV positive patient, the highest was 23 510 Yuan, and the average was 16 070 Yuan. According to the Markov model result, 7.2855 QALYs could be gained per HIV patient on average via HIV testing strategy in 113 hospitals in Guangzhou, and the cost of obtaining one QALY was 2210 Yuan. The cost effectiveness ratio of HIV testing strategy in hospitals in Guangzhou was significantly lower than the standard of WHO recommended, and it was cost-effective to carry out the HIV testing strategy in Guangzhou.

PMD26 Cost Effectiveness of HIV Testing in Non-Traditional Settings – the Hints Study

PMD26 Cost Effectiveness of HIV Testing in Non-Traditional Settings – the Hints Study

The epidemiological impact and cost-effectiveness of HIV testing, antiretroviral treatment and harm reduction programs

To estimate trends in the HIV epidemic in China, and explore the epidemiological impact and cost-effectiveness of expanded voluntary counseling and testing (VCT), antiretroviral treatment (ART), and harm reduction programs in preventing the spread of HIV. A mathematical model was developed and calibrated to reflect the dynamics of disease progression and transmission through sexual contacts and needle sharing in China, and the cost-effectiveness of four interventions was analyzed. Multivariate sensitivity analysis was used to estimate uncertainty ranges for all outcomes. A total of 3.4 million new HIV infections were estimated to occur over the next 30 years if no preventive measures were implemented, of which 75% will occur in high-risk groups, such as injecting drug users (IDUs) and men who have sex with men. Expanding ART treatment is most cost-effective, at 4840 (uncertainty range/UR: 3960-5980) international dollars per quality-adjusted life year gained. The optimal cost-effectiveness path is from ART to the combination strategy of ART and harm reduction, followed by the combination strategy of harm reduction, ART and VCT. Expanded VCT (low-risk once, high-risk annually), expanded ART, harm reduction programs and all combinations of these strategies are cost-effective relative to the base case. In order to bring China to a lower phase of the HIV epidemic, in addition to VCT and ART treatment, efforts in reducing risk behavior will be necessary.

The cost-effectiveness of HIV testing: accounting for differential participation rates.

To understand the impact of differences in participation rates between infected and uninfected individuals on estimates of the cost-effectiveness of HIV screening. Costs per infection detected are modeled as function of both prevalence and serostatus-dependent testing rates. Data from national surveillance surveys, seroprevalence studies, and other sources are employed to suggest the magnitude of results. Differential participation produces a near-doubling in the estimated cost per infection identified. This result is sensitive to assumptions regarding the benefits of screening for seronegatives. Voluntary HIV screening programs may incur prohibitive costs by over-recruiting people at little risk of infection. Failure to account for differential participation can result in over-optimistic cost-effectiveness estimates. However, the relevance of this result--and the significance of both prevalence and participation as cost drivers--is overwhelmed by what is assumed about the benefits conferred to uninfected people by HIV screening.